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Neurotherapeutics

, Volume 16, Issue 3, pp 891–900 | Cite as

Long-Term Follow-up in Patients with Spontaneous Intracerebral Hemorrhage Treated With or Without Surgical Intervention: a Large-Scale Retrospective Study

  • XianXiu Chen
  • Yuan-Chih Su
  • Chun-Chung Chen
  • Jeng-Hung Guo
  • Chih-ying Wu
  • Sung-Tai Wei
  • Der-Cherng Chen
  • Jung-Ju Lin
  • Shwn-Huey Shieh
  • Cheng-Di ChiuEmail author
Original Article
  • 220 Downloads

Abstract

Debates regarding the most beneficial medical or surgical procedures for patients with spontaneous intracerebral hemorrhage (sICH) are still ongoing. We aimed to evaluate the risk of subsequent vascular disease and mortality in patients with sICH treated with and without surgical intervention, in a large-scale Asian population. Patients hospitalized within 2000 to 2013 who were newly diagnosed with sICH were identified using the National Health Insurance Research Database of Taiwan. Neuroendoscopy and craniotomy groups comprised patients who underwent surgical treatment within 1 week, while those in the control group did not undergo early surgical treatment. Outcomes included subsequent hemorrhagic and ischemic stroke, following acute myocardial infarction, congestive heart failure, and mortality. After propensity score matching, there were 663 patients in each group. Compared to that in the control group, the neuroendoscopy and craniotomy groups had a significantly higher risk of secondary vascular events at 1 to 3 months of follow-up (adjusted HR, 2.08 and 1.95; 95% CI, 1.21–3.58 and 1.13–3.35; p < 0.01 and p < 0.05, respectively), but a significantly lower risk after 3 years of follow-up (adjusted HR, 0.52 and 0.52; 95% CI, 0.35–0.78 and 0.35–0.77; p < 0.01 and p < 0.01, respectively). The mortality rate was higher in the craniotomy group at 6 to 12 months of follow-up (adjusted HR, 2.18; 95% CI, 1.06–4.49; p < 0.05) compared to that in the control group. Thus, a timely surgical intervention for hematoma evacuation is advantageous in preventing secondary vascular events and improving outcomes in the long term. However, greater attention to secondary ischemic stroke following the initial sICH episode is needed.

Key Words

Spontaneous intracerebral hemorrhage neuroendoscopy craniotomy subsequent vascular risk stroke mortality 

Notes

Acknowledgments

This study was supported by the China Medical University Hospital (DMR-105-054) and was partially supported by the Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212-133004); China Medical University Hospital; Academia Sinica Stroke Biosignature Project (BM10701010021); MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039-004); Tseng-Lien Lin Foundation, Taichung, Taiwan; Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and the “Chinese Medicine Research Center, China Medical University,” from the Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan (CMRC-CMA-7).

Role of the Funder/Sponsor

The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this

article.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

13311_2019_722_MOESM1_ESM.pdf (498 kb)
ESM 1 (PDF 498 kb)

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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2019

Authors and Affiliations

  • XianXiu Chen
    • 1
    • 2
  • Yuan-Chih Su
    • 3
    • 4
  • Chun-Chung Chen
    • 3
    • 5
    • 6
  • Jeng-Hung Guo
    • 5
  • Chih-ying Wu
    • 5
    • 7
  • Sung-Tai Wei
    • 5
  • Der-Cherng Chen
    • 5
  • Jung-Ju Lin
    • 8
  • Shwn-Huey Shieh
    • 9
  • Cheng-Di Chiu
    • 5
    • 6
    • 10
    Email author
  1. 1.Chinese Medicine Research CenterChina Medical UniversityTaichungTaiwan
  2. 2.Research Center for Chinese Herbal MedicineChina Medical UniversityTaichungTaiwan
  3. 3.School of MedicineChina Medical UniversityTaichungTaiwan
  4. 4.Management Office for Health DataChina Medical University HospitalTaichungTaiwan
  5. 5.Department of NeurosurgeryChina Medical University HospitalTaichungTaiwan
  6. 6.Stroke CenterChina Medical University HospitalTaichungTaiwan
  7. 7.The Graduate Institute of Integrated MedicineChina Medical UniversityTaichungTaiwan
  8. 8.Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
  9. 9.Department of Health Services AdministrationChina Medical UniversityTaichungTaiwan
  10. 10.Graduate Institute of Biomedical ScienceChina Medical UniversityTaichungTaiwan

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